NUR 635 FINAL EXAM
The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired
pneumonia would be:
1.Ciprofloxacin
2.Azithromycin
3.Amoxicillin
4.Doxycycline *** 2.Azithromycin
Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial
evaluation and treatment includes:
1. Reassuring her she has a viral infection and to call if she isn't better in 4 or 5 days
2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure
3. Rapid strep test and symptomatic care if strep test is negative
4. Observation only, with further assessment if she worsens *** 2. Ruling out a hypersensitivity reaction
that may lead to multi-organ failure
Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to
medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his
schizophrenia symptoms, the patient should be assessed by his primary care provider:
1. For excessive weight loss
2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
3. Monthly for tolerance to the haloperidol
4. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients
*** 2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
Digoxin levels need to be monitored closely when the following medication is started:
1. Loratadine
2. Diphenhydramine
,3. Ipratropium
4. Albuterol *** 4. Albuterol
Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma
medications should be used cautiously, if at all?
A.Betamethasone, an inhaled corticosteroid
B.Salmeterol, an inhaled long-acting beta-agonist
C.Albuterol, a short-acting beta-agonist
D.Montelukast, a leukotriene modifier *** B.Salmeterol, an inhaled long-acting beta-agonist
Tiotropium bromide (Spiriva) is an inhaled anticholinergic:
1. Used for the treatment of chronic obstructive pulmonary disease (COPD)
2. Used in the treatment of asthma
3. Combined with albuterol for treatment of asthma exacerbations
4. Combined with fluticasone for the treatment of persistent asthma *** 1. Used for the treatment of
chronic obstructive pulmonary disease (COPD)
Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15
minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is
also prescribed. Teaching regarding her inhalers includes:
1. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day
2. Beclomethasone needs to be used every day to treat her asthma
3. Report any systemic side effects she is experiencing, such as weight gain
4. Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate
bronchodilation *** 2. Beclomethasone needs to be used every day to treat her asthma
When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be
instructed:
,1. Montelukast twice a day is started when there is an asthma exacerbation.
2. Patients may experience weight gain on montelukast.
3. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.
4. Lethargy and hypersomnia may occur when taking montelukast. *** 3. Aggression, anxiety,
depression, and/or suicidal thoughts may occur when taking montelukast.
When educating patients who are starting on inhaled corticosteroids, the provider should tell them that:
1. They need to get any live vaccines before starting the medication.
2. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective.
3. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush.
4. They can triple the dose number of inhalations of medication during colds to prevent needing
systemic steroids *** 3. Patients should rinse their mouths out after using the inhaled corticosteroid to
prevent thrush.
Howard is a seventy-two-year-old male who occasionally takes diphenhydramine for his seasonal
allergies. Monitoring for this patient taking diphenhydramine would include assessing for:
Urinary retention
Cardiac output
Peripheral edema
Skin for rash *** Urinary retention
Second generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies
because they are:
A.More effective than first generation antihistamines
B.Less sedating than the first generation antihistamines
C.Prescription products, therefore are covered by insurance
D.Able to be taken with CNS sedatives, such as alcohol *** B.Less sedating than the first generation
antihistamines
, 4. Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug
Administration due to the:
1. Risk of life-threatening dermatological reactions
2. Increased incidence of cardiac events when LTBAs are used
3. Increased risk of asthma-related deaths when LTBAs are used
4. Risk for life-threatening alterations in electrolytes *** 3. Increased risk of asthma-related deaths
when LTBAs are used
Prior to developing a plan for the treatment of asthma, the patient's asthma should be classified
according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma
symptoms that occur:
1. Daily
2. Daily and limit physical activity
3. Less than twice a week
4. More than twice a week and less than once a day *** 4. More than twice a week and less than once a
day
Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes:
1. Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.
2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.
3. Increase fluid intake to 3 liters per day.
4. Avoid use of aspirin or ibuprofen while using inhaled medications *** 2. Use the inhaled beta-agonist
first, followed by the inhaled corticosteroid.
A stepwise approach to the pharmacologic management of asthma:
1. Begins with determining the severity of asthma and assessing asthma control
The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired
pneumonia would be:
1.Ciprofloxacin
2.Azithromycin
3.Amoxicillin
4.Doxycycline *** 2.Azithromycin
Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial
evaluation and treatment includes:
1. Reassuring her she has a viral infection and to call if she isn't better in 4 or 5 days
2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure
3. Rapid strep test and symptomatic care if strep test is negative
4. Observation only, with further assessment if she worsens *** 2. Ruling out a hypersensitivity reaction
that may lead to multi-organ failure
Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to
medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his
schizophrenia symptoms, the patient should be assessed by his primary care provider:
1. For excessive weight loss
2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
3. Monthly for tolerance to the haloperidol
4. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients
*** 2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
Digoxin levels need to be monitored closely when the following medication is started:
1. Loratadine
2. Diphenhydramine
,3. Ipratropium
4. Albuterol *** 4. Albuterol
Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma
medications should be used cautiously, if at all?
A.Betamethasone, an inhaled corticosteroid
B.Salmeterol, an inhaled long-acting beta-agonist
C.Albuterol, a short-acting beta-agonist
D.Montelukast, a leukotriene modifier *** B.Salmeterol, an inhaled long-acting beta-agonist
Tiotropium bromide (Spiriva) is an inhaled anticholinergic:
1. Used for the treatment of chronic obstructive pulmonary disease (COPD)
2. Used in the treatment of asthma
3. Combined with albuterol for treatment of asthma exacerbations
4. Combined with fluticasone for the treatment of persistent asthma *** 1. Used for the treatment of
chronic obstructive pulmonary disease (COPD)
Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15
minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is
also prescribed. Teaching regarding her inhalers includes:
1. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day
2. Beclomethasone needs to be used every day to treat her asthma
3. Report any systemic side effects she is experiencing, such as weight gain
4. Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate
bronchodilation *** 2. Beclomethasone needs to be used every day to treat her asthma
When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be
instructed:
,1. Montelukast twice a day is started when there is an asthma exacerbation.
2. Patients may experience weight gain on montelukast.
3. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.
4. Lethargy and hypersomnia may occur when taking montelukast. *** 3. Aggression, anxiety,
depression, and/or suicidal thoughts may occur when taking montelukast.
When educating patients who are starting on inhaled corticosteroids, the provider should tell them that:
1. They need to get any live vaccines before starting the medication.
2. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective.
3. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush.
4. They can triple the dose number of inhalations of medication during colds to prevent needing
systemic steroids *** 3. Patients should rinse their mouths out after using the inhaled corticosteroid to
prevent thrush.
Howard is a seventy-two-year-old male who occasionally takes diphenhydramine for his seasonal
allergies. Monitoring for this patient taking diphenhydramine would include assessing for:
Urinary retention
Cardiac output
Peripheral edema
Skin for rash *** Urinary retention
Second generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies
because they are:
A.More effective than first generation antihistamines
B.Less sedating than the first generation antihistamines
C.Prescription products, therefore are covered by insurance
D.Able to be taken with CNS sedatives, such as alcohol *** B.Less sedating than the first generation
antihistamines
, 4. Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug
Administration due to the:
1. Risk of life-threatening dermatological reactions
2. Increased incidence of cardiac events when LTBAs are used
3. Increased risk of asthma-related deaths when LTBAs are used
4. Risk for life-threatening alterations in electrolytes *** 3. Increased risk of asthma-related deaths
when LTBAs are used
Prior to developing a plan for the treatment of asthma, the patient's asthma should be classified
according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma
symptoms that occur:
1. Daily
2. Daily and limit physical activity
3. Less than twice a week
4. More than twice a week and less than once a day *** 4. More than twice a week and less than once a
day
Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes:
1. Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.
2. Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.
3. Increase fluid intake to 3 liters per day.
4. Avoid use of aspirin or ibuprofen while using inhaled medications *** 2. Use the inhaled beta-agonist
first, followed by the inhaled corticosteroid.
A stepwise approach to the pharmacologic management of asthma:
1. Begins with determining the severity of asthma and assessing asthma control
